不同补片植入方法在腹腔镜腹股沟疝修补术的疗效  

Clinical study of different patch implantation in the treatment of inguinal hernia

作　　者：李进[1] 张敏康[1] 郭浩[1] 张前进[1] 孟庆良[1] 田庆中[1] Li Jin;Zhang Minkang;Guo Hao;Zhang Qianjin;Meng Qinliang;Tian Qinzhong(Department of Oncology Surgery, Central Hospital of Xuzhou City, Jiangsu 221000, China)

机构地区：[1]徐州市中心医院肿瘤外科,江苏省221000

出　　处：《中华疝和腹壁外科杂志（电子版）》2018年第2期120-123,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下腹腔内补片植入(intraperitoneal onlay mesh,IPOM)与腹膜前间隙补片植入[腹腔镜经腹腹膜前疝修补术(laparoscopic transabdominal preperitoneal hernia repair,TAPP)和腹腔镜完全腹膜外疝修补术(laparoscopic totally extraperitoneal,TEP)]治疗腹股沟疝的临床效果。比较TAPP和TEP术式的治疗费用和卫生资源利用率。方法回顾性分析2014年6月至2015年12月,徐州市中心医院收治的153例腹腔镜腹股沟疝修补术(laparascopic inguinal hernia repair,LIHR)患者的临床资料,其中IPOM 102例,TAPP 30例,TEP 21例。比较腹腔镜下IPOM与腹膜前间隙补片植入患者的基本信息与术后临床症状等资料。结果 IPOM组和腹膜前间隙补片植入组慢性疼痛患者分别为18例和1例,差异有统计学意义(P<0.05);IPOM组血清肿患者8例,腹膜前间隙补片植入组2例,差异有统计学意义(P<0.05);2组患者在感觉障碍、术后感染、住院时间和复发率等方面差异无统计学意义(P>0.05)。2组患者治疗后其血清基质金属蛋白酶2(matrix metalloproteinase,MMP)-2(97.55±10.26、98.34±11.06)、MMP-9(128.57±10.26、130.94±10.71)水平均有明显降低,与治疗前对比(201.51±14.61、203.61±16.84)、(198.64±12.64、199.07±11.57),差异有统计学意义(P<0.05),组间对比差异无统计学意义(P>0.05)。TAPP和TEP在检查费用、手术费用、药品费用、护理费用、间接成本和总成本上差异无统计学意义(P>0.05)。TAPP和TEP治疗腹股沟疝的疗效相同,但TEP通过减少材料费用提高了资源利用率。结论腹腔镜下IPOM与腹膜前间隙补片植入都是治疗腹股沟疝的有效手术方式,腹膜前间隙补片植入术治疗效果优于腹腔镜下IPOM。Objective To investigate the clinical effect of laparoscopic intraperitoneal implantation（IPOM） and preperitoneal space implantation [laparoscopic transabdominal hernia repair（TAPP） and totally extraperitoneal repair（TEP）] in the treatment of inguinal hernia. The treatment costs and health resource utilization were compared between TAPP and TEP. Methods A retrospective study was conducted on 153 patients with laparoscopic inguinal hernia repair（LIHR） who were treated in Central Hospital of Xuzhou City from June 2014 to December 2015. There were 102 patients undergoing intraperitoneal patch implantation, 30 cases of TAPP, and 21 cases of TEP. The basic information and postoperative clinical symptoms were compared between laparoscopic intraperitoneal patch implantation and preperitoneal space patch implantation. Results There were 18 cases and 1 case of chronic pain in laparoscopic intraperitoneal implantation group and preperitoneal space patch implantation group, respectively. And the difference was statistically significant（P〈0.05）. 8 patients with seroma in laparoscopic intraperitoneal patch implantation group were significantly more than 2 patients in preperitoneal space patch implantation group（P〈0.05）. There were no significant differences in sensory disturbance, postoperative infection, hospitalization time and recurrence rate between the two groups（P〉0.05）. The levels of serum MMP-2 and MMP-9 in the two groups were significantly lower than those before treatment（P〈0.05）. There were no significant differences in examination costs, operation costs, drug costs, nursing costs, indirect costs and total costs between TAPP and TEP（P〉0.05）. TAPP and TEP had same therapeutic effect in the treatment of inguinal hernia. TEP improved resource utilization by reducing the cost of materials. Conclusion Laparoscopic intraperitoneal patch implantation and preperitoneal space patch implantation are effective surgical methods for the treatment of inguinal hernia. The preperitonea

关 键 词：疝 腹股沟 疝修补术 腹腔镜 

分 类 号：R656.21[医药卫生—外科学]